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Understanding and Managing Compulsive Sexual Behaviors




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Men appear to outnumber women with compulsive sexual behaviors. Etiology As with impulse control and substance use disorders, Adult bizarre sexual acts single biological cause has yet been identified to explain the origins and maintenance of compulsive sexual behaviors. Neuroscience research, which would be an excellent approach to understand basic brain differences between those with and without compulsive sexual behaviors, has rarely been applied to this population. In particular, neuroimaging studies in patients with compulsive sexual behaviors would be interesting to compare with those involved in substance abuse and other behavioral addictions.

To date though, most of the neuroimaging work has been done with nonclinical populations and has examined the biology of sexual arousal in healthy subjects. Hypersexual behaviors have been reported in patients with frontal lobe lesion, tumors, and in those with neurological conditions that involve temporal lobes and midbrain areas such as seizure disorders, Huntington's disease, and dementia. Neurotransmitter studies in compulsive sexual behaviors have focused on the monoamines, namely serotonin, dopamine, and norepinephrine.

Normal sexual functioning involves all of these monoamines as evidenced by selective serotonin reuptake inhibitor SSRI -induced sexual dysfunction and the increased sexuality observed among those on stimulants. Cases of hypersexual behavior have also been shown to be induced by medications for Parkinson's disease, implicating dopamine systems in compulsive sexual behaviors. In addition to neurotransmitters, the sex hormones are obviously a critical component to sexual functioning. Testosterone levels have been correlated to sexual functioning but curiously, levels do not necessarily correlate to libido and sexual desires.

It may be that regions of reward and pleasure are modulated by these hormones through facilitating or enhancing the response to sex and the desire for sex. Clinical Assessment Measures There are existing screening instruments, which are only as valid as the responder's honesty and integrity. Although this is true of all psychiatric screening instruments, revealing sexual practices is probably the most humbling because of its private nature. Questions about time spent on sexual activities and impact of functioning are important clinically, but also rely on self-report. Patrick Carnes, one of the pioneers in the field of compulsive sexual behavior research, developed the Sexual Addiction Screening Test, which is a item, self-report symptom checklist that can be used to identify those at risk to develop compulsive sexual behaviors.

Kafka has suggested a behavioral screening test i. Psychosocial Various types of psychosocial treatments are available for individuals suffering from compulsive sexual behaviors.

Nearly, Hirschfeld's area is often revered in the context of breast role specific behavior: But they are also very often.

There is almost no data evaluating their efficacy or effectiveness. Nevertheless, participation in these groups is usually recommended because they Adylt a place for fellowship, support, structure, and accountability, and they are free of charge. Inpatient and intensive outpatient treatment programs for compulsive sexual behaviors usually focus on helping to identify core triggers and beliefs about sexual addiction and to develop healthier choices and coping skills to minimize urges and deal with the preoccupation of sexual addiction. Individual psychotherapy for compulsive sexual behaviors is varied but the two most common approaches are cognitive behavioral therapy CBT and psychodynamic psychotherapy.

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CBT in compulsive sexual behaviors borrows greatly from treatment with substance use disorders, focuses on identifying triggers to sexual behaviors and reshaping cognitive distortions about sexual behaviors e. Psychodynamic psychotherapy in compulsive sexual behaviors explores the core conflicts that drive dysfunctional sexual expression. Themes of shame, avoidance, anger, and impaired self-esteem and efficacy are common. Since there are no biological tests to indicate relapse, collateral history and functioning within the patient's significant relationship tends to be the most reliable markers.

Despite the availability of psychosocial treatments, there are little data documenting treatment outcomes, success rates, predictors of treatment outcome. While preliminary case reports and open-label trials that have been conducted, no known randomized, double-blind placebo-controlled trials have been published. The rationales for these drugs are based on clinical phenomenology and symptoms seen in other disorders, such as substance use or obsessive compulsive disorders. SSRIs have been tried for both paraphilic and non-paraphilic compulsive sexual behaviors through both case series and open-label studies.

Attempting to use SSRIs to create sexual dysfunction through their side effect profile and thus to reduce compulsive sexual behaviors does not appear to be effective. Clinical experience suggests that patients who respond best to SSRIs have co-occurring psychiatric disorders, such as depression, anxiety, or obsessive compulsive disorders. Those who do not have sexual dysfunction from SSRIs have the best treatment response. In addition to SSRIs, naltrexone, an opiate antagonist, has been evaluated in the treatment of compulsive sexual behaviors. Grant describes a case report of co-occurring kleptomania and compulsive sexual behaviors treated successfully with naltrexone after treatment failure with SSRIs and psychotherapy.

In an open-label trial of naltrexone with adolescent sexual offenders, 15 out of 21 patients noted reductions in sexual impulses and arousal. Mood stabilizers, such as valproic acid and lithium, appear promising in the treatment of patients with bipolar disorder and compulsive sexual behaviors. Other medications, such as topiramate and nefazadone, have also been tried, but further replication is needed to determine their effectiveness. There are no known double-blind, randomized studies of anti-androgenic agents in the treatment of non-paraphilic compulsive sexual behaviors. However, case reports and open label studies suggest these may be effective treatments.

Once the medications are stopped, testosterone levels will return to normal levels. This treatment approach has not been utilized in the non-paraphilic sexual behaviors. Conclusions and Future Directions We have much to learn about compulsive sexual behaviors, particularly their neurobiological roots, psychological risk factors, and the impact of societal values on their emergence. For now, compulsive sexual behaviors are the extreme end of a wide range of sexual experience. These behaviors can present in a variety of manners and undoubtedly have many different subtypes, severities, and clinical courses.

Clinicians can enhance the identification and treatment of these disorders by implementing formal screening practices, becoming familiar with the warning signs, and knowing which types of patients are vulnerable. In time, research will begin to uncover the different subtypes of compulsive sexual behaviors as well as determine which treatment and prevention practices work the best. Currently, since there are no guidelines from which clinicians can work, we are left to review the work of those who specialize in the treatment of compulsive sexual behaviors. Carnes P, Schneider JP. Recognition and management of addictive sexual disorders: Guide for the primary care clinician.

Lippincotts Prim Care Pract. Hypersexual disorder and preoccupation with internet pornography. Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association; Many conceptions, minimal data. Weintraub D, Potenza MN. Impulse control disorders in Parkinson's disease. Curr Neurol Neurosci Rep. Compulsive sexual behavior characteristics. Assessment and treatment of compulsive sexual behavior. Essentially, fetishism is the attribution of inherent value or powers to an object. He argued that, in certain vulnerable individuals, an emotionally rousing experience with the fetish object in childhood could lead to fetishism. According to his argument, sexual attractiveness never originates in a person as a whole but always is the product of the interaction of individual features.

He stated that nearly everyone had special interests and thus suffered from a healthy kind of fetishism, while only detaching and overvaluing of a single feature resulted in pathological fetishism. Today, Hirschfeld's theory is often mentioned in the context of gender role specific behavior: Sigmund Freud believed that sexual fetishism in men derived from the unconscious fear of the mother's genitals, from men's universal fear of castration, and from a man's fantasy that his mother had had a penis but that it had been cut off. He did not discuss sexual fetishism in women. InDonald Winnicott presented his theory of transitional objects and phenomena, according to which childish actions like thumb sucking and objects like cuddly toys are the source of manifold adult behavior, amongst many others fetishism.

He speculated that the child's transitional object became sexualized. Both male and female rats will develop a sexual preference for neutrally or even noxiously scented partners if those scents are paired with their early sexual experiences. Sleeping Sex Sexsomnia is a rare sleep disorder that prompts an individual to seek sexual activity in their sleep. Although most reported cases involve men, both males and females may initiate sleep sex. Those who identify as omo become aroused when they have a full bladder and wet themselves, or observe their partner wetting themselves. Spanking Art Spanking art is generally enjoyed by people who identify as spanking enthusiasts in the bedroom.

Spankophilia is a paraphilia characterized by arousal from spanking or being spanked.

Somnophilia Somnophilia is erotic arousal dependent upon the act of intruding on a stranger mid-sleep, Adilt waking someone up adts erotic bixarre. Teratophilia Bizarrre is a sexual fetish that involves being attracted to people with physical deformities. There are many subsets of teratophilia specific to different types of human deformities. For instance, acrotomophilia involves sexual attraction to amputees and stigmatophilia refers to deriving sexual pleasure from people Adhlt bodies are marked or scarred in some way. People who gravitate towards poop play experience sexual pleasure through the act of crapping on another person or being crapped on, for instance.

Breath Play Breath play involves the restriction of oxygen to the brain to achieve a heightened orgasm. Self-induced breath play during masturbation is known as autoerotic asphyxiation. Mechanophilia Mechanophilia is characterized by sexual attraction to machines, sometimes a desire to engage in sexual relations with or in an airplane, car, bicycle, or helicopter. While some find creative ways to have sex with balloons, others simply enjoy the sight of their partner sitting on a balloon and popping it. Others are aroused by actions performed with the hand, whether overtly sexual e.

In sensation play, the physical stimuli e. These sexual fetishes are yet more specific think attraction to people with neck braces or arousal from vomit and more obscure. But they are also very real. What can we say?

The world is a fascinating place, especially when bjzarre comes to human sexual behavior. Pygophilia — Attraction to the human butt. Salirophilia — The love of getting dirty or getting your Adylt dirtyliterally, prior to or during sexual intercourse. Katoptronophilia bizafre Intense sexual satisfaction derived from mirrors, often satisfied by having sex, stripping, or masturbating in front mirrors. Food Fetish — While some foods are actually aphrodisiacs because they have properties that induce sexual desire, sexual food play can involve any food that a person finds sexually stimulating.

Food play is a form of sitophilia, which refers to arousal by erotic scenes centering food. Microphilia — Sexual attraction to small people or tiny things. This is not about anal penetrationthough it can lead there. Tricophilia — Arousal from hair.


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